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  • 1
    Electronic Resource
    Electronic Resource
    Hyperlipidemia in acute hemolysis (1991)
    Springer
    Journal of molecular medicine 69 (1991), S. 426-429 
    Details
    ISSN: 1432-1440
    Keywords: Hemolysis ; Triglycerides ; Hyperlipidemia ; Microcirculation ; Diffuse intravascular coagulation ; Acute renal failure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In 27 (78%) of 36 patients with massive hemolysis (defined as a fall in hematocrit of more than 12% within 12 h due to intravascular red cell destruction), hypertriglyceridemia (plasma triglycerides 〉 175 mg/dl) was present or appeared within two days after the hemolytic crisis. Eighteen subjects with triglycerides exceeding 300 mg/dl (peak 516 ± 39 mg/dl) were further analyzed. The development of hyperlipidemia was independent of the etiology of hemolysis (microangiopathic hemolytic disease 7, toxicemia 3, parainfectious complications 3, autoimmune hemolysis 2, glucose-6-phosphate dehydrogenase deficiency 2). Factors known to increase plasma triglycerides, such as shock, infections, or pancreatitis, were present in only a few cases. Hemolysis-associated complications were activation of intravascular coagulation (16), coma (13), acute renal failure (13), and respiratory insufficiency (5), organ dysfunctions indicating diffuse microvascular injury. Plasma triglycerides fell within a few days if the cause of red cell destruction was eliminated. In 5 of the 8 patients presenting with triglycerides below 175 mg/dl, severe hepatic dysfunction was present. We conclude that hemolysis causes transient hyperlipidemia, either directly by red cell destruction or indirectly by inducing intravascular coagulation, and possibly due to both increased triglyceride synthesis and decreased catabolism.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01666827
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  • 2
    Electronic Resource
    Electronic Resource
    Pancreatitis in acute hemolysis (1991)
    Springer
    Annals of hematology 63 (1991), S. 39-41 
    Details
    ISSN: 1432-0584
    Keywords: Hemolysis ; Pancreatitis ; Microcirculation ; Diffuse intravascular coagulation ; Acute renal failure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Forty cases of hemolysis (drop of hematocrit 〉 12%/12 h) were retrospectively analyzed for hyperamylasemia and pancreatic complications. In 15 subjects the serum amylase level was 〉 360 U/l, i.e., three times the normal range, in ten the amylase level exceeded 900 U/l. Excluding patients in circulatory shock and/or hepatic coma, acute pancreatitis as defined by an elevation of serum amylase and clinical signs (epigastric pain) was present in four, with additional ultrasound findings (pancreatic swelling) and/or laparatomy/postmortem findings in a further six subjects (total ten patients = 25%) with various causes of hemolysis: autoimmune hemolysis 2, microangiopathic hemolytic anemia 2, toxicemia, G-6-PDH deficiency, septic abortion, malaria, Wilson's disease, and hypophosphatemia, one case each. In all subjects acute renal failure and in seven an activation of intravascular coagulation was seen. Three patients died (33% vs 47% of all hyperamylasemic patients and 46% of the whole group), but none of the deaths was attributed to pancreatitis. Pancreatic postmortem findings were diffuse edema and patchy parenchymal necrosis in two cases and petechial bleeding in one case. We conclude that acute pancreatitis is a complication of massive hemolysis, occurring at a prevalence of above 20%. It may progress from diffuse edema and inflammation to focal necrosis, rarely if ever to gross hemorrhage, and does not contribute to the high mortality of massive hemolysis. Back pain in hemolysis might originate from the pancreas rather than from the kidneys.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01714959
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  • 3
    Electronic Resource
    Electronic Resource
    The cumulative dosage of epinephrine used during resuscitation: A predictor for the quality of neurologic outcome after cardiac arrest (1996)
    Springer
    Intensive care medicine 22 (1996), S. S91 
    Details
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Conclusion A cumulative dosage of more than 5 mg epinephrine used during resuscitation after cardiac arrest is a predictor for bad neurologic outcome.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01921265
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  • 4
    Electronic Resource
    Electronic Resource
    The association between blood lactate concentration on admission, duration of cardiac arrest, and functional neurological recovery in patients resuscitated from ventricular fibrillation (1997)
    Springer
    Intensive care medicine 23 (1997), S. 1138-1143 
    Details
    ISSN: 1432-1238
    Keywords: Key words Cardiac arrest ; Cardiopulmonary resuscitation ; Outcome ; Lactate
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To assess the association between arterial lactate concentration on admission and the duration of human ventricular fibrillation cardiac arrest, and to what degree the arterial lactate concentration on admission is an early predictor of functional neurological recovery in human cardiac arrest survivors. Design: Cohort study. Arterial lactate concentrations and out-of-hospital data concerning cardiac arrest and cardiopulmonary resuscitation were collected retrospectively according to a standardized protocol. Functional neurological recovery was assessed prospectively at regular intervals for 6 months. Setting: Emergency department of an urban tertiary care hospital. Patients: A total of 167 primary survivors of witnessed out-of-hospital ventricular fibrillation cardiac arrest. Measurements: The association between arterial lactate concentration on admission, the duration of cardiac arrest, and functional neurological recovery was assessed. Further, we assessed whether admission concentrations of arterial lactate and duration of cardiac arrest can predict unfavorable functional neurological recovery. Functional neurological recovery was measured in cerebral performance categories (CPC). No or minimal functional impairment (CPC 1 and 2) was defined as favorable outcome; the remaining categories (CPC 3, 4 and 5) were defined as unfavorable functional neurological recovery. Results: In 167 patients, a weak association between total duration of cardiac arrest and admission levels of lactate (r = 0.49, P 〈 0.001) could be shown. With increasing admission concentrations of arterial lactate functional neurological recovery was more likely to be unfavorable (OR 1.15 per mmol/l increase, 95 % CI 1.04–1.27). Nevertheless, only at very high levels of lactate (16.3 mmol/l) could unfavorable neurological recovery be detected with 100 % specificity, yielding a very low sensitivity of 16 %. Conclusions: The arterial admission lactate concentration after out-of-hospital ventricular fibrillation cardiac arrest is a weak measure of the duration of ischemia. High admission lactate levels are associated with severe neurological impairment. However, this parameter has poor prognostic value for individual estimation of the severity of subsequent functional neurological impairment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050470
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  • 5
    Electronic Resource
    Electronic Resource
    Bleeding complications during the early phase of thrombolytic therapy with tissue-type plasminogen activator (1996)
    Springer
    Intensive care medicine 22 (1996), S. S86 
    Details
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Conclusion Severe bleeding complications during the early phase of thrombolytic therapy are rare, the majority of bleeding complications does not cause haemodynamic compromise. In few patients the location of the bleeding itself poses a significant hazard to the patient.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01921260
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  • 6
    Electronic Resource
    Electronic Resource
    Safety and efficacy of urapidil and sodium nitroprusside in the treatment of hypertensive emergencies (1997)
    Springer
    Intensive care medicine 23 (1997), S. 885-888 
    Details
    ISSN: 1432-1238
    Keywords: Key words Hypertensive emergencies ; Urapidil ; Sodium nitroprusside
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To assess the safety and efficacy of urapidil compared to sodium nitroprusside in the treatment of hypertensive emergencies. Design: randomized, prospective clinical study. Setting: Emergency department in a 2000-bed inner city hospital. Patients: Eighty-one patients with hypertensive emergencies defined as elevation of systolic blood pressure above 200 mmHg and/or diastolic blood pressure above 110 mmHg plus evidence of end-organ damage were included in the study protocol. The efficacy of therapy was defined as 1) blood pressure reduction below 180/95 mmHg within 90 min and 2) no re-elevation of blood pressure during a 4-h follow-up period in primary responders. The safety of both drugs was defined as the number of minor and major side effects during treatment. Interventions: Patients received either sodium nitroprusside (n = 35; continuous intravenous administration with a starting dose of 0.5 μg/kg per min; increase in increments of 0.5 μg/kg per min every 15 min until response to treatment or a maximum of 3 μg/kg per min) or urapidil (n = 46; intravenous bolus; starting dose: 12.5 mg; repetitive administration of 12.5 mg every 15 min until response or a maximum dose of 75 mg). Measurements and results: Blood pressure was measured every 2.5 min by using a non-invasive oscillometric blood pressure measurement unit. Response to treatment within 90 min was observed in 75 (93 %) patients (urapidil: n = 41 [89 %]; nitroprusside: n = 34 [97 %]; p = 0.18). During the follow-up period 8/34 (24 %) patients in the nitroprusside group and 1/41 (2 %) patients in the urapidil group exhibited blood pressure re-elevation. Major side effects were observed in seven patients receiving nitroprusside and two patients in the urapidil group (p = 0.04). Conclusion: Urapidil is equally effective, compared to sodium nitroprusside, in the treatment of hypertensive emergencies. Due to a smaller number of adverse events, urapidil is a reasonable alternative to nitroprusside in the treatment of hypertensive emergencies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050426
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  • 7
    Electronic Resource
    Electronic Resource
    Diagnosis of gallbladder perforation in acute acalculous cholecystitis in critically ill patients (1992)
    Springer
    Intensive care medicine 18 (1992), S. 245-246 
    Details
    ISSN: 1432-1238
    Keywords: Acalculous cholecystitis ; Alkaline phosphatase ; Cholecystectomy ; Gallbladder perforation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In the presence of ascites ultrasound is not appropriate to distinguish between gallbladder perforation and acute acalculous cholecystitis. However, the correct and early diagnosis of gallbladder perforation is important for the treatment and prognosis. We report 4 critically ill patients with ascites. All patients had evidence of gallbladder perforation by ultrasound and underwent cholecystectomy: 2 patients had gallbladder perforation, but 2 had acalculous cholecystitis without perforation. markedly elevated serum alkaline phosphatase was the only discriminating finding indicating gallbladder perforation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709841
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  • 8
    Electronic Resource
    Electronic Resource
    Influence of fluid replacement on extravascular lung water (EVLW) in patients with diabetic ketoacidosis (1988)
    Springer
    Intensive care medicine 14 (1988), S. 201-205 
    Details
    ISSN: 1432-1238
    Keywords: Diabetic ketoacidosis ; Fluid replacement ; Extravascular lung water ; Colloid-osmotic pressure ; Pulmonary hemodynamics ; Pulmonary gas exchange
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Fluid replacement is a major issue in the treatment of patients with diabetic ketoacidosis. During this therapy, development of pulmonary edema has been reported and attributed to an increase in pulmonary microvascular pressure and a decrease in colloid-osmotic pressure (COP). Because clinically apparent pulmonary edema is associated with an increase in extravascular lung water (EVLW) and impairment of pulmonary gas exchange, we studied the effect of fluid replacement on EVLW, COP, pulmonary hemodynamics and gas exchange parameters in 8 patients with diabetic ketoacidosis (blood glucose〉300 mg/dl, pH〈7.1). EVLW was estimated by the thermal-dye technique. All variables were successively determined upon adminssion (A), after initial fluid replacement (IFR), when glucose had fallen below 180 mg/dl, after 8 h of intravenous glucose treatment (G), and after 24 h of total parenteral nutrition (TPN). Despite a total net fluid intake of 6.0±1.61, a significant decrease (p〈0.001) in COP from 29.6±5.5 at A to 18.8±2.2 mmHg after TPE and a significant increase (p〈0.001) in PCWP from 4±2 at A to 10±3 mmHg after TPE, EVLW remained almost unchanged. EVLW was 5.1±2.8 at A, 5.3±2.1 after IFR, 4.8±1.4 after G, and 5.3±1.7 ml/kg after TPN. However, PaO2 decreased from 137±17 at A to 87±10 mmHg after TPE (p〈0.001), while Qs/Qt increased significantly (p〈0.05). The alterations in gas exchange may be indicative of pulmonary dysfunction but as they were not associated with accumulation of EVLW, they may as well reflect the compensation of metabolic derangements in diabetic ketoacidosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00717987
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  • 9
    Electronic Resource
    Electronic Resource
    Evoked potentials in severe herpes simplex encephalitis (1991)
    Springer
    Intensive care medicine 17 (1991), S. 94-97 
    Details
    ISSN: 1432-1238
    Keywords: Herpes simplex encephalitis ; Diagosis ; Prognosis ; Evoked potentials
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Diagnostic and prognostic value of evoked potentials (EP) were studied in 5 patients with severe herpes simplex encephalitis (HSE). Latency of the third negative cortical N70 peak, elicited by median nerve stimulation, was prolonged in 3 survivors with Glasgow coma score of ≤6 (115 vs 71 ms in controls,p〈0.05), but normal after improvement of the acute disease, N70 right to left interhemisphere difference was increased initially in the 4 survivors (26 vs 3 ms in controls,p〈0.05) indicating focal brain involvement, a crucial finding in HSE. The first cortical N 20 peak was preserved in all survivors even during deep coma where evaluation of brain function is difficult. Auditory brainstem EP were normal in all patients and useful to exclude brainstem death. In severe HSE, somatosensory long-latency EP are an effective monitor of the level of impaired consciousness and can detect brain focal signs. Short-latency N20 components may be predictive of the outcome.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01691430
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  • 10
    Electronic Resource
    Electronic Resource
    Einsatz der perkutan implantierbaren Herz-Lungen-Maschine beim präklinischen Kreislaufstillstand? (1998)
    Springer
    Intensivmedizin und Notfallmedizin 35 (1998), S. 1-2 
    Details
    ISSN: 1435-1420
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003900050112
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